Florida Blue, Service Advocate III, State Group Contact/Claims, Jacksonvill at Florida Blue

, , United States -

Full Time

Start Date

Immediate

Expiry Date

31 Aug, 26

Salary

27.0

Posted On

02 Jun, 26

Experience

0 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Customer Service, Claims Adjudication, Problem Solving, Communication Skills, Empathy, Research, Insurance Policy Knowledge, Call Resolution

Industry

Insurance

Description

Start date: 7/20/2026 Training duration and hours: 7/20/2026 - 9/25/2026 Monday through Friday from 8:30 am to 5pm EST. Shift after training: Department hours 7:00 am- 7:00 pm, Monday through Friday, EST, an 8-hour shift will be determined based on shift bid. This posting will come down on: 05/28/26 at 5 pm EST Set pay rate for the role: $18.51 Job Summary: The role of Service Advocate is focused on servicing current or potential customers (which are defined as members, providers, agents, brokers, benefit administrators or benefits consultants). Incumbents resolve questions and issues, help the Company's customers utilize products, tools and services and directly contribute to customer satisfaction and retention. Essential Functions: The essential functions listed represent the major duties of this role, additional duties may be assigned. The work of a Service Advocate III is guided by instructions, established work routines and/or close supervision. Incumbents are given some latitude on deciding on how tasks and duties are completed based on changing work situations, workflow, etc. and supervisory approval. Incumbents perform semi-routine duties within established systems and procedures. Example job duties may include: * Provide assistance to State members by responding to benefit and claim related inquiries via telephone and in writing. * Utilize the Florida Blue Call Strategy to provide outstanding customer service and call resolution to our members; follow-up on issues to ensure resolution for customer. * Educate and answer member questions on the access and use of member self-service tools. * Perform research, request additional information from the provider, member and/or supporting plans if necessary, and make decisions to return, pend, pay or deny low risk claims in order to properly adjudicate claims and inquiries within contract benefit and claims processing guidelines. * Evaluate data through questioning, probing, and reasoning for process improvements. * Research and resolve service-related inquiries for members and providers, meeting established expectations for quality, productivity and timeliness. * Provide customer service and education to plan members and providers by answering more complex questions regarding insurance claims and policies, resolving issues and ensuring customers understand the Company’s products, services and processes. Calls are predominantly routine, but may require deviation from standard screens, scripts and procedures. You will work across multiple business areas and utilize various systems, tools, and resources to resolve service inquiries. This role will require you to have the ability work an assigned shift between 7:00 AM and 7:00 PM, Monday – Friday with occasional overtime, weekends and holidays as business needs require. Paid training for this position will be provided, you will have to successfully complete assigned training class. Required Work Experience: * 0-1 year of related work experience or equivalent combination of transferable experience and education * Ability to resolve/respond to customer inquiries and concerns, using sound problem solving and decision-making skills. * Demonstrated empathy and compassion, with outstanding listening and communication skills. * High school diploma or GED Preferred Experience: * 1 or more years work experience related to Health Insurance claims or Health Insurance customer service. Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. What We Offer: As a Florida Blue employee, you will be at the heart of GuideWell’s vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living. To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to: * Medical, dental, vision, life and global travel health insurance; * Income protection benefits: life insurance, short- and long-term disability programs; * Leave programs to support personal circumstances; * Retirement Savings Plan including employer match; * Paid time off, volunteer time off, 10 holidays and 2 well-being days; * Additional voluntary benefits available; and * A comprehensive wellness program Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ. To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases. Hourly Pay Range: $18 - $27 Hourly Hiring Rate: $18.51 Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring. We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

Responsibilities

The Service Advocate III resolves member and provider inquiries regarding health insurance benefits and claims. They utilize company tools to educate customers on self-service options and ensure timely resolution of service-related issues.